"My heart feels like it's racing"



57 yo male with history of hypertension presents to the hospital with persistent "heart racing" and shortness of breath with exertion. He is a healthy, athletic man who was in his normal state of health until about 1 week ago when he began feeling "off." He states that he first noticed his typical workouts were a lot more difficult. Initially he thought he was just out of shape, but the symptoms persisted. He was in California for a week with his family prior to the start of this.


Over the past 2 days his symptoms have gotten worse. He feels like his heart races with minimal exertion, and his breathing is significantly worse. He takes amlodipine for his blood pressure and no other medications or over the counter drugs. He has no family history of cancer or blood clots, his father died at 81 from heart disease. Denies any leg swelling, chest pain, nausea or vomiting. No fevers or cough. He presents to the emergency room on day 7 of his symptoms.


VITALS

T 98.2 HR 108 (125 with minimal exertion) BP 110 / 76 SPO2 95% on room air RR 18


PHYSICAL EXAM

Gen: In no distress, appears comfortable at rest

CVD: tachycardic, no murmurs

Lungs: clear bilaterally; no wheezing

ABD: soft, nontender

Extremities: No edema or unilateral swelling


NOTABLE LABS / TESTS

WBC 13, Hemoglobin 13, Platelet 200k

Cr 0.8, BUN 25

Troponin 0.04, Lactate 1.0, BNP 200

LFTs unremarkable


EKG: Sinus tachycardia

CXR: unremarkable


POCUS:


Lung


Anterior

Posterior


CARDIAC

Parasternal Long

Parasternal Short

Other cardiac views were technically difficult and not obtained


LOWER EXTREMITY


Right Common Femoral / Greater Saphenous Junction


R Femoral


Left Femoral


Left Popliteal


What is the Diagnosis? How do you manage this condition?


Click here for answers and pearls.


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